Saturday, May 07, 2016

Kulik and Glantz Response to Criticism of their Paper is Censored by Journal, Undermining Its Own Conflict of Interest Policies

According to a commentary posted last week on Dr. Stan Glantz's blog, the journal Addiction has refused to publish a response he wrote to a critique of an article he and Dr. Margarete Kulik had published in the journal Tobacco Control on the "hardening" hypothesis of smoking cessation.

Drs. Kulik and Glantz published the original article in Tobacco Control on June 24, 2015. In February 2016, the journal Addiction accepted for publication a manuscript by Plurphanswat and Rodu which provided a critique of the Kulik and Glantz article. Drs. Kulik and Glantz were therefore invited to submit a response to the manuscript, which is customary practice for every journal. Authors whose papers are criticized are always given an opportunity to respond to the criticism.

Drs. Kulik and Glantz did submit a response to the critique. In their response, they made two major points. First, they noted that one of the authors of the critique has a substantial conflict of interest because of his previous and current funding by tobacco companies and they explained how and why this conflict needs to be considered in evaluating the validity of the critique. Second, they pointed out what they claimed was a statistical error in the critique which invalidated the analysis.

The journal responded by refusing to publish their response and instead, ordering them to remove all reference to the conflict of interest if they wished to have their response published:

"Thank you for your reply to the Rodu and Plurphanswat Journal Club
article. Ultimately, regardless of what we might perceive as potential
biases in the reasons for conducting studies, or as here, follow-ups of
published studies, it is the science that must either stand or fall on
its technical merits. In the final section of your reply article,
starting, "The substance of...," you appear to make a strong case that
Rodu and Plurphanswat's science may not stand up. This is extremely
important to focus on. To this end, I would like to publish this section
alone, and to give the authors the opportunity to reply. If you are
willing to do this, I would also ask you to change the title of your
letter to something more along the lines, "Model over-specification and
the hardening hypothesis". If you are agreeable to this plan, please resubmit your paper as a
revision, including the section I mention above and a new title... ."

Kulik and Glantz protested this decision, arguing that the conflict of interest was entirely relevant to the evaluation of the validity of the critique and that leaving this section out would not accurately reflect their views:

"Making the changes that you request will mean that the resulting manuscript would not fairly represent our point of view. Therefore, we request that our comment be published as submitted."

The journal rejected this request, and instead of publishing the critique and an author's reply, it apparently will only publish the critique:

"I am truly sorry that you have declined for a second time to accept the
journal’s offer to publish the key scientific part of your letter, which
I believe may have had sufficient substance to not go unchallenged. I
am also somewhat surprised at your decision on this occasion, because I
know you to be a pre-eminent worker in this field who always tries to
place scientific probity and the unbiased interpretation of data before
all else."

The Rest of the Story

In my view, the story here is essentially one of censorship. It is important to note that when asking authors to provide a response to criticism of their work, journals typically allow authors wide discretion to respond as they see fit. The response is not subject to the type of rigorous review that an original manuscript would receive because the authors essentially have a "right" to respond to the criticism of their article.

Of course, the journal will screen the response for any material that is inappropriate or out of line, but I have never seen a journal dictate the grounds upon which the authors can respond to the criticism. And I have never seen a journal dictate that the authors cannot use a particular line of argument in responding.

It is entirely appropriate to address conflicts of interest that are present because these conflicts may well have influenced the conduct of the research and the interpretation and reporting of the results. Addressing and considering conflicts of interest is not only a legitimate aspect of responding to a critique, but it is a "scholarly" response. Kulik and Glantz went beyond the call of duty here and provided a detailed accounting of the conflict of interest, noting and documenting the conflicts with 26 references (which is very strong documentation considering that this is merely a response to a critique).

To argue that addressing conflicts of interest is not relevant to evaluating a manuscript is to undermine the entire purpose of requiring that such conflicts be disclosed. Essentially, what the journal is saying is that while they require authors to disclose conflicts, they do not see those conflicts as having any relevance to the evaluation of the research. Well if that is the case, then why bother publishing the conflict of interest disclosures?

The very purpose of disclosing conflicts of interest is to allow readers to take that conflict into consideration in evaluating the validity of the article.

Now I firmly believe that one should never simply dismiss an article because of a conflict of interest; every article must also be evaluated in terms of its scientific content. However, it is not appropriate to go to the opposite extreme and argue that conflicts of interest must be ignored. Both are legitimate and important points to consider in evaluating a paper. And in this case, Kulik and Glantz did also address the scientific aspects of the statistical analysis conducted in the critique.

The rest of the story is that the refusal to allow the authors to address conflicts of interest present in the paper criticizing their work essentially amounts to censorship. The journal is dictating the scholarly points that can and cannot be made and not allowing the authors discretion in how they respond to criticism of their own work. Moreover, the arguments made by the journal in rejecting the authors' response undermine the entire purpose of conflict of interest disclosure.

We do not publish conflict of interest disclosures and then right after that, publish an additional disclosure which reads: "In evaluating this paper, please ignore the above conflicts of interest." But that is exactly what the journal is asking its readers to do.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.